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APPLICATION FO._ <br />the Eve <br />ltt OF <br />ct"OF °'"" <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />259-8810 <br />In nFMnI ITHIN ❑ COMBINATION ❑ BUILDING 0 MECHANICAL <br />PKPLUMBING <br />❑ SIGN <br />GLNERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE <br />PLUMBING CONTRACTOR <br />MAII. ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE <br />f! J. ✓Z TdL�l.- <br />I{L-t<r-�. l L 25� <br />6 "1*r CL a fJ E )7LCiktat. l, 1 f�,v _ <br />9-l• Lio 12 <br />02PL w 14 4 IQ/� <br />CLASS OF WGRK. <br />[I El <br />ALTERATION ❑ <br />REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ <br />BUILDING RELOCATION <br />CO NEW ADDITION <br />VALUATION CF WORK(COST OF MAIORALS PLUS LABORI <br />op pb <br />I "I 0U <br />DESCRIBE WORK <br />s. <br />— <br />UDEOFBUILDINO <br />11A." (nJ ea� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMUJFD THIS AP• <br />PLICATION AND KNOWTHE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED I:ERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE '"1 <br />X / OR ' �_ s' I <br />LEGAL OESCRIPTIYISHOWN BELOWOR ATTACH FOUR COPIES) <br />ONOFPROPERT <br />LOT— BLOCK --OF <br />PROJECT ADDRESS <br />3I.) _ ,£S, F. <br />APPLICANTS CN BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/HNDLR UNITS — H.P. <br />BATHTUB <br />REFRIGERATION UNITS — M.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS — B.T.U./H. P. <br />GAS FIRED ABC UNITS—B.T.U. <br />SHOWER <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS — C.T.U. M EA, <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />ASHER <br />EVAPORATIVE COOLERS <br />CLOTHESDRYERS <br />OUNTAIN <br />VENTILATION FAN <br />IN <br />fROOF <br />RANGE HOOD <br />PREVENTERS <br />WATER HEATER <br />NS — RAIN LEADERS <br />WOOD STOVEICE <br />— BAR. ETC I <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />f <br />SUBTOTAL <br />�— <br />PERMIT <br />f <br />i <br />F, <br />PERMIT <br />TOTAL FEE <br />f <br />TOTAL FEE <br />SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />f PONT SETBACK _REAR <br />SETBACK SIDE <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />-' <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC. LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED O YES ❑ NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATIONA� <br />I PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />PUBLICWORKS <br />TOTAL <br />...... mR nFTF RMI NING ALL <br />rnvrcr <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />